Statins and Musculoskeletal Conditions, Arthropathies, and Injuries

Study Questions:

Is statin use associated with musculoskeletal conditions, including arthropathy and injury, in physically active persons?

Methods:

A retrospective cohort study was performed in a military health care system evaluated from October 1, 2003, to March 1, 2010. Statin use was determined during fiscal year 2005. On the basis of medication fills, patients were divided into two groups: statin users (received a statin for at least 90 days) and nonusers (never received a statin throughout the study period). Using patients’ baseline characteristics, a propensity score was used to match statin users and nonusers; odds ratios (ORs) were determined for each outcome measure. The occurrence of musculoskeletal conditions was determined using prespecified groups including all musculoskeletal diseases (Msk1), arthropathies and related diseases (Msk1a), injury-related diseases (dislocation, sprain, strain) (Msk1b), and drug-associated musculoskeletal pain (Msk2).

Results:

A total of 46,249 individuals met study criteria (13,626 statin users and 32,623 nonusers). Of these, the authors propensity score–matched 6,967 statin users with 6,967 nonusers. Among matched pairs, statin users had a higher odds ratio (OR) for Msk1 (OR, 1.19; 95% confidence interval [CI], 1.08-1.30), Msk1b (OR, 1.13; 95% CI, 1.05-1.21), and Msk2 (OR, 1.09; 95% CI, 1.02-1.18); the OR for Msk1a was 1.07 (95% CI, 0.99-1.16; p = 0.07). Secondary and sensitivity analyses revealed higher adjusted ORs for statin users in all outcome groups.

Conclusions:

The authors concluded that musculoskeletal conditions, arthropathies, injuries, and pain are more common among statin users than among similar nonusers. The full spectrum of statins’ musculoskeletal adverse events may not be fully explored, and further studies are warranted, especially in physically active individuals.

Perspective:

Rates of statin-associated muscle symptoms from randomized clinical studies are 1.5%-3.0%, and from observational studies, approximately 10%. The usual clinical thought is that statins result in myalgias and weakness. But this study describes an increase in acutely strained tendons, muscles, and joints using matching and propensity scores, which suggests that the association is real. On the other hand, cumulative simvastatin years was not a significant predictor of any of the outcome measures. We have no data on whether statins influence the recovery from the injuries.

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Nonstatins, Novel Agents, Statins, Heart Failure and Cardiac Biomarkers

Keywords: Outcome Assessment (Health Care), Hydroxymethylglutaryl-CoA Reductase Inhibitors, Tendons, Cardiovascular Diseases, Pain, Musculoskeletal Pain, Musculoskeletal Diseases, Simvastatin, Antigens, CD58, Tendon Injuries, Myalgia


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